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Norris Gentry, Marshall, North Carolina
There is NO doubt that the current path of Healthcare and cost in America can not be sustained. It is another "victim" of an economic and political evolution that has created a "culture of denial" surrounding many critical issues. Many seem surprised at the rise of Donald and Bernie. They should not! Many American know we can, should and at a certain point MUST address these issues. A beginning is to have the courage to admit we have the problem Our political and economic system MUST undergo internal changes OR the public will rise up and change it for us. We can feel the "ground shifting". Be involved. Speak out to any elected official you can find. Stand up for your RIGHT to healthcare. Be an involved Citizen. The fate of the Republic depends on that!!

Free market competition is the best way yet found to deliver many consumer goods and services, but that does not mean it is a panacea for every situation. In primary healthcare there are some fundamental pitfalls in a private system as it seeks to maximise profit by attracting paying customers. But the people in the World who have the greatest healthcare needs are the poor, and they have no purchasing power at all. As a result their needs remain largely ignored, both in rich and poor countries alike.

Also In theory a private hospital will become more profitable as their customer's health deteriorates, increasing demand. By contrast in a public health system, such as the UK, the government has a huge incentive to encourage healthier lifestyles and preventative medicine, which will significantly reduce future expenditure. Furthermore, accees to public health records offers huge advantages for medical research and trials programs.

This is not to say that private industry should have no part to play in healthcare. Best solutions will vary from country to country, but this must be done in a way to ensure that profit motivations work to the benefit of patients, not shareholders. Just one simple example of how profit motivations distort healthcare provision come from a recent UK scandal over testing by the high street pharmaceutical retailer Boots :
https://www.theguardian.com/business/2016/apr/13/boots-staff-under-pressure-to-milk-the-nhs-says-pharmacists-union
Private provision in healthcare may seem attractive, but the arguments in favour of a public healthcare system are very powerful, and deserve serious consideration.

This sounds good and in theory would be correct. The fact of private sector competition in the US healthcare sector is one of collusion between insurers, overwhelming administrative expenses and corporate profits exacted from providers and patients alike. Probably only in the banking sector are theory and reality more at odds. As always, the reality is that the insiders get rich and society gets the bill.

"A system based on competition among health insurers, which are funded through risk-independent contributions and tax subsidies, would be more patient-friendly, more efficient, and, most important, it would deliver a higher standard of care."

Fortunately there is a country which has conducted this experiment. We live in it.

The biggest issue is not the efficiency of provision, although that is important. Ther biggest issue is that we face longevity, an aging demographic and expanding medical capability.

The older you get the more healthcare services you consume, the skew in the demographic demands more, and the constant development of treatments and new drugs. New treatments expand scope of treatment, new drugs are at the start of their product life therefore expensive and expand the menu.

How a healthcare system says 'no' is unfortunately as important as how it says 'yes' to treatment request, ultimately it has to be a rationing system and it will get progressively worse. That is the biggest headache.

This is also not just a matter of services, it covers issues like heart transplants. As the health of the population improves the number of hearts available decline and as expertise improves surgery cost decline. The result is a shortage of hearts available for transplant and the balck and white of yes or no you can or can't have one

In the UK with the NHS there is constant warfare on the nature of service provision with pressure groups campaigning for access to denied treatment and constant pressure to more efficiently deliver treatment

What would be far more pertient than this ridiculously shallow article would be an assessment of the economic benefits of new service delivery methods including digital medic to patient communication and AI diagnostic techniques

Update- In the above comment, I misunderstood what I think the quoted sentence is saying slightly. If I understand correctly, tightly regulated competition among for-profit health care providers, negotiating with a central funding authority, would provide the best outcome. This actually sounds very much like a version of Medicare or single-payer health care in other countries, with perhaps some nuances in the understanding of "competition", "regulation", and "efficiency".

The conflation of competition with privatization is something that we are used to hearing from free-market purists, who tend to set up systems that, in one way or another, circumvent the intent of the regulation mechanisms and take advantage of them, with the term "competition" being the fulcrum of a bait-and-switch operation which has played out a lot.

The US healthcare system is regarded as one of the most expensive in provision of services per specific service. Therefore there has to be a better way. That better way will inevitably involve stripping profit and possibly personnel out of the system - eg bureaucratic claims processors and ambulance chasers.

An industry consuming 18.4% of GDP will fight to retain the status quo which is what it is doing. Whether Sanders US economic growth projections are right is neither here nor there, his central comment is sound - reform. Furthermore it is not as though economist get their projections right - take a look at the IMF record which is abysmal. Quite frankly the lady doth protest too loudly.

On the subject of drugs, there is data around which shows the US paying 2x the price of the same item in Europe. A typical General Practitioner in the EU will issue scripts in a total value more than their salary suggesting savings could be worthwhile

BTW just a small point, B Sanders will not win; whether H Clinton takes the Sanders proposal is up to her team, most likely not